Routine vaccinations and child survival in a war situation with high mortality:: effect of gender
Routine vaccinations and child survival in a war situation with high mortality:: effect of gender
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DOI：
10.1016/s0264-410x(02)00441-3
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发表时间：
2002-11-22
期刊：
影响因子：
5.5
通讯作者：
Lisse, I
中科院分区：
文献类型：
--
作者：
Aaby, P;Jensen, H;Lisse, I
接种疫苗的非特异性影响可能对男孩和女孩不同。由于疫苗的顺序接种，很难区分不同疫苗的效果。我们测试了白喉，破伤风，百日咳（百白破）和脊髓灰质炎疫苗和麻疹疫苗在最近的战争（1998年）在几内亚比绍的性别特异性的影响时，没有在该国的免疫规划。这项研究包括比绍四个城区的1 491名1-17个月的儿童。在战前3个月，对研究区的疫苗接种状况进行了评估。对未接种麻疹疫苗的儿童评估了百白破三联疫苗和脊髓灰质炎疫苗的效果。对6-17月龄儿童进行麻疹疫苗接种效果评价。与未接种麻疹疫苗的儿童相比，接种麻疹疫苗的儿童死亡率较低（死亡率（MR）= 0.44（95% CI 0.20-1.00）），女孩差异显著（0.25（0.09-0.71）），但男孩差异不显著（0.84（0.26-2.75））（同质性检验，P = 0.095）。如果在分析中删失麻疹病例，接种疫苗和未接种疫苗儿童的死亡率为0.38（0.16-0.89）。DTP和脊髓灰质炎疫苗接种儿童的死亡率并不低于未接种疫苗的儿童。DTP和脊髓灰质炎疫苗接种儿童的女性-男性死亡率比为3.08（1.11-8.56），麻疹疫苗接种儿童的女性-男性死亡率比为0.63（0.28-1.40），这是两个比率的显著倒置（同质性检验，P = 0.013）。不同的女性-男性死亡率比例不太可能用不同疫苗的不同方向的选择偏差来解释。与麻疹疫苗接种相关的减少与预防麻疹感染无关。接种疫苗的非特异性影响应分别对男孩和女孩进行评估。考虑到这些影响可能会对发展中国家的儿童死亡率模式产生影响。(C)2002爱思唯尔科技有限公司版权所有。
Non-specific effects of vaccination may be different for boys and girls. Due to the sequential administration of vaccines, it is difficult to separate the effect of different vaccines. We tested sex-specific effects of diphtheria, tetanus, pertussis (DTP) and polio vaccines and measles vaccines during the recent war (1998) in Guinea-Bissau when there was no functioning immunisation programme in the country. The study included 1491 children aged 1-17 months in four urban districts in Bissau. Vaccination status had been assessed in the study area in the 3 months before the war. The effect of DTP and polio vaccines was assessed for children who had not received measles vaccine. The effect of measles vaccine was evaluated for children aged 6-17 months. Compared with measles-unvaccinated children, measles-vaccinated children had lower mortality (mortality ratio (MR) = 0.44 (95% CI 0.20-1.00)), the difference being marked for girls (0.25 (0.09-0.71)) but not for boys (0.84 (0.26-2.75)) (test of homogeneity, P = 0.095). If measles cases were censored in the analysis, the mortality ratio for vaccinated and unvaccinated children was 0.38 (0.16-0.89). DTP and polio-vaccinated children did not have lower mortality than unvaccinated children. The female-male mortality ratio for DTP and polio-vaccinated children was 3.08 (1.11-8.56) and 0.63 (0.28-1.40) for measles-vaccinated children, a significant inversion of the ratios (test of homogeneity, P = 0.013). The divergent female-male mortality ratios are unlikely to be explained by a selection bias going in different directions for different vaccines. The reduction associated with measles vaccination was unrelated to prevention against measles infection. Non-specific effects of vaccination should be assessed separately for boys and girls. Taking these effects into consideration may have implications for child mortality patterns in developing countries. (C) 2002 Elsevier Science Ltd. All rights reserved.